Season and region of birth as risk factors for coeliac disease a key to the aetiology?

Abstract

Background

Coeliac disease (CD) incidence has increased in recent decades, characterised by variations according to sex, age at diagnosis, year of birth, month of birth and region of birth. Genetic susceptibility and exposure to gluten are the necessary factors in CD aetiology, although several environmental factors are considered.

Methods

A nationwide prospective cohort longitudinal study was conducted consisting of 1 912 204 children aged 0–14.9 years born in Sweden from 1991 to 2009. A total of 6569 children were diagnosed with biopsy-verified CD from 47 paediatric departments. Using Cox regression, we examined the association between CD diagnosis and season of birth, region of birth and year of birth.

Results

Overall, CD risk was higher for children born during spring, summer and autumn as compared with children born during winter: adjusted HR for spring 1.08 (95% CI 1.01 to 1.16), summer 1.10 (95% CI 1.03 to 1.18) and autumn 1.10 (95% CI 1.02 to 1.18). Increased CD risk was highest if born in the south, followed by central Sweden when compared with children born in northern Sweden. Children diagnosed at <2 years had an increased CD risk if born in spring while those diagnosed at 2–14.9 years the risk was increased for summer and autumn births. The birth cohort of 1991–1996 had increased CD risk if born during spring, for the 1997–2002 birth cohort the risk increased for summer and autumn births, while for the birth cohort of 2003–2009 the risk was increased if born during autumn.

Conclusions

Season of birth and region of birth are independently and jointly associated with increased risk of developing CD during the first 15 years of life. Seasonal variation in infectious load is the likely explanation.

Journal

Journal ID (nlm-ta): Arch Dis Child

Journal ID (iso-abbrev): Arch. Dis. Child

Journal ID (hwp): archdischild

Journal ID (publisher-id): adc

Title: Archives of Disease in Childhood

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 0003-9888

ISSN (Electronic): 1468-2044

Publication date (Print): December 2016

Publication date (Electronic): 15 August 2016

Volume: 101

Issue: 12

Pages: 1114-1118

Affiliations

[1 ]Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University , Umeå, Sweden

[2 ]Department of Food and Nutrition, Umeå University , Umeå, Sweden

[3 ]Department of Clinical Sciences, Pediatrics, Umeå University , Umeå, Sweden

Author notes

[Correspondence to ] Fredinah Namatovu, Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå SE-901 87, Sweden; fredinah.namatovu@ 123456epiph.umu.se

Article

Publisher ID: archdischild-2015-310122

DOI: 10.1136/archdischild-2015-310122

PMC ID: 5256417

PubMed ID: 27528621

Copyright statement: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

License:

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Categories

Subject: 1506

Subject: 1612

Subject: Original Article

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